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Home My WebLink AboutEAGLE RIVER HEIGHTS NORTH BLK 4 LT 8 GI?~TER ANCHORAGE AREA BOROIS~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 708 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: MAILING _ ADDRESS'~)/j' ~ ~"~~--~c/'~'~'~ PHONE-~.~' LEGAL DESCRIPTION '~97~.~'~'~'~-~., '~-~'~' NUMBER OF ~.~ DISTANCE FROM WEL[ ~'~'"/'~'.,~Z///~ ¢.9 MATERIAL -~'"~'~-~--~"~-~ COMPARTMENTS /~ ~/'~"~~ /-'/~'~/~'~'--~/'~,'~' LIQUID LIQUID CAPACITY .//~) ~J ~2 GALLONS. INSIDE LENGTH '""TNSIDE WIDTH ~ DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl ~' ~ J~'-~' NEAREST LOT LINE SEEPAGE PiT: OUTSIDE DIAMETER OR WIDTH , LENGTH , DEPTH ( .~ AV~'~J"~ _ . DISTANCE FROM WELL ~'~'/~,.'~f //-~') . BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) _~,-~ _~,/' SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH FOUN~ , NEAREST LOT LINE DISTANCE FROM WELL / , ' NUMBER OF~ DISIANCE BETWEEN LINES~ TRENCH WIDTH / IN, TOTAL EFFECTIVE ~EPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE.__ WELL: TYPE ~,/~.,'~,,//'~/' DEPTH ,.~ DISTANCE FROM WATER ~ . , , BUILDING FOUNDATION, ~ SAMPLE , NEAREST NEAREST SEPTIC ~ SEEPAGE ~ OTHER LOT LINE ~ , SEWER LINE ~'~ , TANK , SYSTEM ~"-'-. CESSPOOL , SOURCES DISTANCES: DIAGRAM OF SYSTEM I DATE HEALTH AUTHORIIY GAAB-HD-2 GREATET ANCHORAGE AREA ' ~)ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. f.J~,~// SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT App LiCANT/.4~ NAME OF RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK LOCATION OF INSTALLATION , SEEPAGE PIT , DRAIN FIELD. TO SERVE THE FOLLOWING FACILITY F,NANCED T..OUG"r¢' BE'NSTALLED .Y PERCOLATION TEST RESULTS /00~//~ ANTICIPATED DATE OF COMPLETION ,OTHER BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .~--~ · SEPTIC TANK SIZE /'O~C")~ .TYPE -~-~-~ SEEPAGE AREA ~-'-~C~3 J~ TYPE /-'~J .. DIAGRAM OF SYSTE~ DISTANCES: I certify that I am familiar with the requirements of Greater Anchorage//Area BoroJ~gh Ordinances.., .--,N°' 28-68 and that the above described system is in accordance with said code. /// .~ DATE ~,~:::~ -- / -- ~/ APP L' CANTS SI 6 NAT U¢.~'"'/~~'~~-~'¢~- '' Municipality of Anchorage Environmental Protection 825 L S~reet Anchorage, Alaska 99501 REQUEST FOR APPROVAL'OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspectio. n: CNRO Property Owner: Mailin§ Address: Hailing Address: ~.~,. /~/~ 4. ;~ame of Lending Institution: o Nailing Address: Day Phone~?~-'~,W~F~ '; f fr77 . Name of Realtor or Agen~'~. ~.Y/~///z/,,.,,' ' ' Mailin~ Address: Legal Description: Type of Facility to be inspect'ed: Type of Sapply: P~ Utility /X Individual If' Individual, 'number of dwelli'n§s, pre.sehtly served Bdfms..~ -, If Individual, depth of well Sewage Disposal-System Type .of S~stem: Public Utility ....... If Individual, date of installation "individual (on-site) /Y 27 ... REALTORS® VIRGINIA L. KOHFIELD Associate Eagle River Area, Inc. Realtors Parkgate Professional Bldg. Eagle River, Alaska 99577 Bus. (907) 694-9555 Res. (907) 694-9183 D~PAF, MUNICIPALITY OF ANCHOP.-~G=- ~Z~ A~m ~ ' OF HEALTH AND ENVIRON, .~ ,L PROTECTION,~ ~.~.~_~_~t~~~//~ L Street, Anchorage, Alaska 99501 279-251l, ext. 224 or 225 Date ~/~~~'5 Date ~~P/~s~ ~) Date LendLng Instil. ut]on Request: Peoples Bank and Trust Mailing A. dd_eso: Pouch 7-007 99510 Phone: 279-7511 Prop<~rty Owner: Dick and Suzy Smith Phone: 694-9169 Mailing Address: Post Office Box 368 99577 3.~.~,.~gam~ : Description.: Lot 8 Block 4 ~gle River Heights S~.nglc Family Residence: (x) ~u]._~ple FamJ. l~ Resi. dence: ( ) Well System: Permit ConstructJ on Number of Bedrooms: Number of Bedrooms: u Indiv].cual ~,eii ~ Com~unity/P bi' System Depth of Well Well Log on File ( ) Bacterial Analysis Sowage Disposal System: Permit # Septic Tank Size ~b~{ouption Area On-site System ~x) Public Utility.. Installed __!_9. 7._1 .... In s t a 11 e r. _~_~_~OC_ ~ ~. /_~_~___O_ .......... Manufacturer 9~-~ ~ · Soils Nate C} O~ Material ';. D~stanc~s:' ~ e. 1] to Septic Tank to Absorption Area tc Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line P a. gc~- ~i~o '' ' Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities f,egai Description: Lot 8 Block 4 Eaqle River Heiqhts Subdivision Corr~ment s: A~ fadav~t Attached: ( ) Letter Attached: ( ) Date: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: INSPECT: TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR 1. APPROVAL REQUESTED BY: 2, PROPERTY OWNER: ~~ PHONE: 3. LEGAL DESCRIPTION: 40fY ~ '~ 7~ ~ TYPE FAC[L[TY TO BE [NSPECTEO:~;~~,/z STREET: NUHBER OF BEDROOHS: 5. ~ELL DATA: B. DEPTH C. SIZE D. CONSTRUCTION E. BACTERIAL ANALYSIS o SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) SIZE / d)O 2. AGE /9 '~ ! 3. MANUFACTURER .,~'~'"'~'~ ~ 4. INSTALLER APPROVAL REQUEST FOR SEWER & WATER FACILITIES PAGE TWO o B. SEEPAGE PIT 1. SIZE 2. LINING DISPOS~FIELD 1. NUMBE~k~ LINES 2 TOTAL LEN1}-~H REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT C. WELL TO SEWER LINE E. F. G. H. WELL TO PROPERTY LINE WELL TO OTHER POSSIBLE CONTAMINATION FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEEPAGE PIT TO PROPERTY LINE 8. COMMENTS: ~ · ~DISAPPROVED: APPROVED'DATE: ,D~~ DATE: APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY ENA Form 2575 Fo~m A~proved FEDERAL H01~$1NG ADMINISTRATION Budget Bureou No, 63-R02C)6 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.gTO BE COMPLETED BY FHA INSURING OFFICE IMORTGAGEE Anchorage, Alaska I Peoples MOITGAGOI 01~ SPONSOE Associate Builders SU"O,V,S,ON NA&e Ea,qle River Hei,~hts TO?&L I~MUI: SASEMENT Bank and Trust SERIAL NO. PROPERTY ADDRESS Chatanika F-l New installation Lo 0 p_~_ e River LOT N~. Cee attic or ogher eel. be ~e In~ (If Yes, ~w [~ Public system [] Community system SiWAOI DISPOSAL BY: [] Public system [] Community system [] Individual PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPART/v~NT INSPECTOR'S SKETCH It is the opinion of the [] State ['-1 County [] Local Department of Health that this individual water-supply system [] is [] is not ~tisfactory as a domestic water supply for the subject property. Pub 1 i c Water It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage.disposal sys- tern with proper maintenance: [-'~ Can be expected to function satisfactorily, and is not likely to create an insanitary condition ]Cannot' be expected to function satisfactorily Oct. SIGNATUE§ /~ ~ ~ !TITLE , ! Environmental Soecialist NOTE: The heolth authority should complete the oppropriote opinion statement above and affix date, signature end rifle in the spaces provided. Uso of tho above arid for Health Deportment Inspector's sketch os well as use of tho beck of this form is et tho option of the hoollh authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that thc Individual w~Iter-supply system be considered [] Acceptable [] Not Acceptable Sewage dispOsal be considered [] Acceptable [] Not Acceptable, IDATE CHeF ARCHITECT DEPUTY FC~ CNfEF ARCHfTECT SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATIR SUPPLY AND SIWAOI DISPOSAL SYSTEM FHA Peym 2173 Rev. July ItS! REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PIIMAIY TIEATMENT consiscs of [] Septit tank. [] Cesspool. Distance from ~cll,~eeL Material ~ Total liqmd capa~i~, gallons Capac.y inl~ ~ompa.ment, Inside length ....... lc.ct Inside width __ f~t Liquid depth. Co~I: gallons. feet. Distance fr,,m: Well feet; fi~undation, ___feet; nearest lot line at [] front, [] side, [] rear. Inside diameter, __ feet. Depth,. tcet. Liquid capacity. .gallons Lining material SiCOflDAIIY TREATMENT consists of [] Tile disposal field [] Seepage pits. Other Th DaSlaeSal Field: Distance from: Well. Total len~h of tile lines. Trench width Length of each line,_ feet; foundati,)n, feet; nearest loc line at [] front, [] side, [] rear, feet. Number of lines,__ Distance between lines, inches. Total effective absorpt.~n area in bottom of trenches feet. Depth. top of tile to finish gra~e,__ Type of filter material: [] Gravel. [] Broken stone Other. Depth of filter material beneath tile ~ inches. Number of pits .... Outside diameter, t~et. Depth,. Distance from: Well, Inspection mode by: [] State . feet. feet. square feet. inches. Depth of filter material over tile, feet. Lining material inches. feet; building foundation,.__ feet; nearest lot line at [] front, [] side, [] rear, [] County. [] Local Health Authority. Inspected by 19__ (T~TLe) REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM Distante to nearest public water main,__ feet. Size of main, inches. Individual wells [] are [] are not cusu.nary in neighborho~<l. Give most recent rccord of failure of wells in immediate v~omty to furnish adequate supply of water Properties in neighborhood [] are [] are not being developed with both individual water-supply and sewage-disposal systems. L.t size' feet wide .... feet deep. Dwelling set back from front property line, feet. Individual water supply fi'om: [] Dr,lied well. [] [')riven well. [] Dug well. [] Bored well. ~atence of well fearn: Building fi)u ndation.. seepage pit. feet; tile sewer, feet; cesspool, .feet; nearest lot line at [] front. [] side. [] rear, leer; septic tank, feet; disposal field, feet; other sources o( possible pollution, feet. Diameter. inches. Total depth, feet Type of casing, Approximate depth ro pumping level of water in well, feet. Approximate yield, Sealed watertight to depth of feet. Exterior space around casing sealed with: [] Cement grout. [] Puddled clay. [] Ordinary backfill. Well cover: [] Concrete. [] Wood. [] Metal. Openings in well cover watertight: [] Yes. [] No. Pump: [] Shallow well. [] Deep well. Lengxh of drop pipe, feet. %rap capacity, la)cared in: [] Basement. [] Pumproom off basement. [] Pumphouse ah~e ground. [] Pump pit. Pumproom properly drained: [] Yes. [] No. Pump mounting watertight: [] Yes. [] No. Type of storage: [] Pressure. [] Gravity. Capacity, gallons. Has bacteriological examination o£ water been made? [] Yes. [] No. If answer is "yes," gi~e date Quali~ of water [] is [] is not satisfactory for human consumption, Installation [] does [] does not comply with approved exhibits, if any. Inspection made by; [] State. [] County. [] Lo(al Health Authority. Inspected by Date of inspection , 19__ feet; Depth of casing, .feet. .gallons per minute. gallons per minute. 19 (TITLE) GPO 8894188 06-1220(a~ Rev. 1~;,;3' /i~~-~DEPARTMENT OF, ~!~!L~TII AND SOCIAL' Dm 0N OF HEALTH BACTERIOLOGICAL-;WATER ANALYSIS INDIVIDUAL ~ SEMI~PUBLI HLORINE RESIDUAL PPM REPORT RESULTS TO NAME ~ ~r CITY ZIP CODE ADDRESS · / ~ Cffi~E THIS S~ll~ ONLY IF WA~ ~ AN INDIVIDUAL S~Y DATE CO~TED ~/ 3 / 7 7 TIME COLLECTED ~ p ~ ~mle CoIIKt~ F~ [ ~tchtn Tap ~ Bmhr~ Tap ~ b~ent Tap T~ -- ;~ W~ ~ C~cr~e ~ ~ Op~ Top ~ Concr~e L~ATION: ~ In ~t ~ Bal~ent ~s~ ~ Under Building ~r ~ptlc DIST~CE TO= or ~h~ Dralna~ Pi~ ~t, Tank ~ Cess- ~NERAL: ~s Water ~mme Muddy or DiKobred? ~ Y~ ~? Dib~meter of We~l Depth ~h of Watec Depth ~MP L~ATION: ~ In Well ~ ~t ~ In Basement On Top PUR~E OF E~INATION: Iline~ Susa? ~ Yes ~w ~e of Suppl~ ~ Y~ F~L Feet, In Utility Room [] No [~ No Repak$ to System? [] Yes ~1~ Signature READ INSTRU~CTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lab No. OFFICE Analy~,'- slmws th;s Water SAMPLE to be: [] Unsatisfactory [] (~u~estionable [] SaMple too long i. traesJtj sampJe should not be over 48 ~aurs old at examleaf'toe to indicate reliable results. Please sen.~l new sample. [] Bottle broken in trandt, please send new sample. SANJTARI~N'S REMARKS o6-122o :b~ BAC/TE'~IOLOGICAL WATER ANALYSIS RECORD Rev. 1973 Lactose Broth .' ' r · 1Oct 10c¢ lOcc Ill)Cc 10cc 1.0cc 1.0cc 24 H~Jrs ~ ~ ~ ~ ~ Brilliant areas1 24 Hours 48 Hours , ' - ~ EMB AGAR Lactose Broth, 24 hrs. 48 hrs. Groin's stein Cdlform Density (Moat probable I~. per lO0ec) MI: Results ~ ...o..d by _? -~'1 ii Prmnt